20 Questions: Terry L. Wahls, MD – Internal Medicine
Created January 25, 2016 by Juliet Farmer
Terry Wahls, MD, is a clinical professor of medicine at the University of Iowa, where she teaches internal medicine residents, sees patients in the traumatic brain injury clinic and conducts clinical trials. In addition, she’s director of the Extended Care and Rehab Service Line at the Veteran Affairs Iowa City Health Care System. She received a bachelor’s degree in fine arts from Drake University in Des Moines (1976), a Doctor of Medicine from University of Iowa in Iowa City (1982), and an MBA from University of St. Thomas in Minneapolis (2001). Dr. Wahls completed a residency in obstetrics and gynecology at Barnes Hospital, Washington University in St. Louis, as well as a residency in internal medicine at University of Iowa Hospitals & Clinics.
Dr. Wahls has been published in numerous media journals, including Journal of the American Medical Women’s Assoc., Human Pathology, Journal of General Internal Medicine, Journal of Ambulatory Care Management, Journal of Urology, American Journal of Medicine, Annals of Internal Medicine, Journal of Alternative Complementary Medicine, and Journal of Degenerative and Neuromuscular Disease. Dr. Wahls is a patient with secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years, and she is currently conducting clinical trials testing the effect of nutrition and lifestyle interventions to treat MS.
When did you first decide to become a physician? Why?
I graduated with a bachelor’s degree in fine arts with a focus on painting. Instead of pursuing a master’s degree of fine arts, I decided to study the sciences and medicine. I loved anatomy and the chance to make a difference in people’s lives.
How/why did you choose the medical school you attended?
I decided to apply only to schools in Iowa to reduce the size of debt burden upon graduation.
What surprised you the most about your medical career?
After 20 years of clinical practice, I was diagnosed with progressive multiple sclerosis. I saw the best doctors in the country, but nobody could help slow the rapid progression of the disease, so I started looking for other answers. Fortunately, I discovered the Institute of Functional Medicine and started taking their Continuing Medical Education Courses on neuroprotection. I used the concepts I had learned from their courses to begin experimenting on myself. Just by adjusting my nutrition, I began to recover. In only a year, I went from a tilt-recline wheelchair to being able to bike 20 miles. This transformation changed how I understood disease and health, how I practiced medicine, and my research.
I became much more excited about medicine. I was re-energized and passionate about getting to the root cause of why people become ill. In so doing, I began to focus on nutrition, motivational interviewing, exercise, stress reduction, cellular physiology, biochemistry, and the microbiome.
Why did you decide to specialize ininternal medicine?
It allowed me to have ongoing relationships with my patients, which I find very satisfying.
If you had to do it all over again, would you still become a physician? Why or why not? What would you have done instead?
Yes, I would still become a physician. I love what I do and the ability to positively impact people’s lives.
Has being a physician met your expectations? Please explain.
In retrospect, I really did not understand what being a physician would be like. Nor did I understand how rigorous the years of training would be.
What do you like most about being a physician?
I love helping people understand the importance of their lifetime of choices: environmental exposures (including foods eaten and not eaten), daily physical activity, stress-reducing practices, strength of social and family network, smoking status, toxins to which they have been exposed, and infection history. These factors all speak to their DNA and help turn some of their genes “on” and other genes “off,” which shifts how their cells conduct the chemistry of life. Those shifts can change a healthy, disease-resistant body into an inflamed, sickly, disease-prone body. Once my patients understand that their choices about lifestyle and food can create health or disease, most begin adopting and sustaining significant changes like eating vegetables, dropping sugar, and increasing their physical activity.
Once people understand how their health behaviors affect their cells, they are much more interested in learning how to create the healthiest environment for their cells and therefore their bodies. Then we teach them how to adopt a more nutrient-dense, less inflammation-promoting diet, how to adopt a stress-reducing practice, and how to incorporate physical activity into their daily routine. As patients adopt these changes, their pain decreases, energy improves, mood improves, and they need less and less medication.
What do you like least about being a physician?
Managing the clinical practice when the computer system is down.
Describe a typical day at work—walk me through a day in your shoes.
I get up at 5:30 a.m. First I meditate, and then I do my morning exercise program, which includes strength training, balance training, and stretching. I bike five miles to work. I am the chief of Extended Care and Rehabilitation Service Line at my hospital, so four days a week I am either doing administrative work or meeting with my research team. One day a week I do clinical work and run the Therapeutic Lifestyle classes. These are shared medical appointments with eight to 40 people where I teach what diet and lifestyle choices can shift your gene activity and promote a healthy body.
On average, how many hours a week do you work? How many hours of sleep do you get per night? How many weeks of vacation do you take annually?
I leave for work at 7:30 a.m. and am usually home by 5:30 p.m. I sleep between seven and eight hours most nights. I take four weeks of vacation each year.
If you have family, do you feel you have enough time to spend with them? Why or why not?
We have always made it a priority to eat dinner together as a family. During the meal we review our days, and when the kids were young, we reflected on how we observed examples of a specific value (we focused on one each month) playing out in our choices (or the choices of someone we had observed) that day. It was a great way to teach our children (and remind ourselves) that a person’s character and values are manifested by the choices they make every day.
How do you balance work and your life outside of work?
We make decisions collectively about how to spend our vacations, so that everyone in the family has a voice in deciding where we go and what we do each year. We also divide up household chores fairly. I love my work, and I love the time we spend together as a family.
Do you feel you are adequately compensated in your field? Please explain.
I teach the public and also have my own business teaching people that our choices are the most critical determinant in whether we have healthy, disease-resistant bodies or sickly, disease-prone bodies. Between the income I receive from my business and my work at the Veterans Hospital and the University of Iowa, I am well compensated.
If you took out educational loans, is/was paying them back a strain? Please explain.
It has not been a burden. I graduated with debt equivalent to the cost of a new starter home in my community. I have chosen to live simply all my life, and the debt repayment has not been difficult.
In your position now, knowing what you do, what would you say to yourself back when you started your medical career?
[Regarding patient treatment,] it is all about lifestyle choices, not about drugs.
What information/advice do you wish you had known prior to medical school?
The same: Health is all about lifestyle choices, not about drugs. Physicians who practice the most health-promoting behaviors will be the most effective at teaching their patients why and how to adopt and sustain those behaviors.
From your perspective, what is the biggest problem in health care today? Please explain.
Most physicians are well-trained to use drugs, surgeries, and devices to treat symptoms. But they have little training or insight into the critical role of health behaviors in treating chronic disease. As a result, symptoms are temporarily controlled but underlying disease processes are not and continue to make the patient ill, requiring more and more medication to control their disease. Over time, more disease states will develop because the lifestyle factors contributing to the development of the inflamed, sickly, disease-prone body are never addressed.
Where do you see internal medicine in five years?
Hopefully more and more internal medicine physicians will be fired up about making good diet and lifestyle choices for themselves and teaching their patients why and how to use those choices to improve their health and vitality.
What types of outreach/volunteer work do you do, if any?
I teach classes online and in person about the power of diet and lifestyle to restore health. I gave a TEDx talk about using diet to restore my health, which has been viewed 2.25 million times. The talk describes how I reversed seven years of steady decline due to progressive multiple sclerosis, four of which I spent in a tilt-recline wheelchair, by changing my diet and lifestyle. That talk has inspired millions to rethink their approach to health and has encouraged them to ask their physicians about the link between diet choices and health.
What’s your final piece of advice for students interested in pursuing a career in internal medicine?
Creating health through eating more vegetables, engaging in a daily stress-reducing practice, and moving your body is the most powerful tool you have for treating and preventing chronic disease in yourself and your patients.